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	    <title>社会保障卡挂失补卡登记(市)</title>
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	    <script src="${pageContext.request.contextPath }/scripts/boot.js" type="text/javascript"></script>
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  <body>
   <form id="form1" method="post">
 	 <!-- ============================== 第一部分 查询条件================================================== -->
 	<!--  <fieldset style="border:solid 1px #aaa;padding:3px;height:25px;width:50%;height: 100%"> -->
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 	   		<table style="width:100%;border:solid 1px #aaa;" >
 	   			<tr style="width:100%;">
 	   				<td style="width:10%;text-align: right;">补卡原因:</td>
 	   				<td style="width:15%;"><input id="bkyy" name="bkyy" class="mini-combobox" emptyText="请选择补卡原因..." style="width:100%;"/></td>
 	   				<td style="width:10%;text-align: right;">社会保障卡号:</td>
 	   				<td style="width:15%;"><input id="aac001" name="aac001" class="mini-textbox" emptyText="请输入卡号..." style="width:100%;"/></td>
 	   				<td style="width:50%;"></td>
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 	   		</table>
 	   	</div>
 	   	
 	 <!-- ============================== 第二部分 查询结果================================================== -->
 	 <fieldset style="border:solid 1px #aaa;height:100%;width:98%;">
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 	  		<table style="width:100%;" cellpadding="3" cellspacing="0">
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 	  				<td style="width:10%;text-align: right;white-space: nowrap;">姓名:</td>
 	  				<td style="width:15%;"><input id="aac003" name="aac003" class="mini-textbox" style="width:100%;"/></td>
 	  				<td style="width:10%;text-align: right;white-space: nowrap;">性别:</td>
 	  				<td style="width:15%;"><input id="aac004" name="aac004" class="mini-combobox" style="width:100%;"/></td>
 	  				<td rowspan="13" style="width: 50%;"><img style="border:1px solid #666666;height: 100%;width: 100%"/></td>
 	  			</tr>
 	  			<tr style="width:100%;">
 	  				<td style="width:10%;text-align: right;white-space: nowrap;">出生年月:</td>
 	  				<td style="width:15%;"><input id="aac006" name="aac006" class="mini-datepicker" style="width:100%;"/></td>
 	  				<td style="width:10%;text-align: right;white-space: nowrap;">民族:</td>
 	  				<td style="width:15%;"><input id="aac005" name="aac005" class="mini-combobox" style="width:100%;"/></td>
 	  			</tr>
 	  			<tr style="width:100%;">
 	  				<td style="width:10%;text-align: right;white-space: nowrap;">银行类型:</td>
 	  				<td style="width:40%;" colspan="3"><input id="bankt" name="bankt" class="mini-combobox" style="width:100%;"/></td>
 	  			</tr>
 	  			<tr style="width:100%;">
 	  				<td style="width:10%;text-align: right;white-space: nowrap;">银行卡号:</td>
 	  				<td style="width:40%;" colspan="3"><input id="aae009" name="aae009" class="mini-textbox" style="width:100%;"/></td>
 	  			</tr>
 	  			<tr style="width:100%;">
 	  				<td style="width:10%;text-align: right;white-space: nowrap;">通卡卡面号:</td>
 	  				<td style="width:40%;" colspan="3"><input id="caz002" name="caz002" class="mini-textbox" style="width:100%;"/></td>
 	  			</tr>
 	  			<tr style="width:100%;">
 	  				<td style="width:10%;text-align: right;white-space: nowrap;">姓名拼音码:</td>
 	  				<td style="width:40%;" colspan="3"><input id="aaz742" name="aaz742" class="mini-textbox" style="width:100%;"/></td>
 	  			</tr>
 	  			<tr style="width:100%;">
 	  				<td style="width:10%;text-align: right;white-space: nowrap;">证件类型:</td>
 	  				<td style="width:40%;" colspan="3"><input id="aac058" name="aac058" class="mini-combobox" style="width:100%;"/></td>
 	  			</tr>
 	  			<tr style="width:100%;">
 	  				<td style="width:10%;text-align: right;white-space: nowrap;">证件号:</td>
 	  				<td style="width:40%;" colspan="3"><input id="aac002" name="aac002" class="mini-textbox" style="width:100%;"/></td>
 	  			</tr>
 	  			<tr style="width:100%;">
 	  				<td style="width:10%;text-align: right;white-space: nowrap;"><span style="color:blue;">发证机构:</span></td>
 	  				<td style="width:40%;" colspan="3"><input id="aaz768" name="aaz768" class="mini-textbox" style="width:100%;"/></td>
 	  			</tr>
 	  			<tr style="width:100%;">
 	  				<td style="width:10%;text-align: right;white-space: nowrap;"><span style="color:blue;">联系电话:</span></td>
 	  				<td style="width:40%;" colspan="3"><input id="aae005" name="aae005" class="mini-textbox" style="width:100%;"/></td>
 	  			</tr>
 	  			<tr style="width:100%;">
 	  				<td style="width:10%;text-align: right;white-space: nowrap;"><span style="color:blue;">联系地址:</span></td>
 	  				<td style="width:40%;" colspan="3"><input id="aac046" name="aac046" class="mini-textbox" style="width:100%;"/></td>
 	  			</tr>
 	  			<tr style="width:100%;">
 	  				<td style="width:10%;text-align: right;white-space: nowrap;">联系地址邮编:</td>
 	  				<td style="width:15%;"><input id="addyb" name="addyb" class="mini-textbox" style="width:100%;"/></td>
 	  				<td style="width:10%;text-align: right;white-space: nowrap;"><span style="color:blue;">银行:</span></td>
 	  				<td style="width:15%;"><input id="aae008" name="aae008" class="mini-combobox" style="width:100%;"/></td>
 	  			</tr>
 	  			<tr style="width:100%;">
 	  				<td style="width:10%;text-align: right;white-space: nowrap;">备注:</td>
 	  				<td style="width:40%;" colspan="3"><input id="aae013" name="aae013" class="mini-textbox" style="width:100%;"/></td>
 	  			</tr>
 	  			<tr>
 	  				<td style="width:10%;text-align: right;white-space: nowrap;">领取网点\地址:</td>
 	  				<td style="width:15%;"><input id="lqdz" name="lqdz" class="mini-combobox" style="width:100%;"/></td>
 	  				<td style="width:25%;" colspan="2"><input id="lqdz1" name="lqdz1" class="mini-combobox" style="width:100%;"/></td>
 	  				<td style="width:50%;" colspan="2" ><input id="lqdz2" name="lqdz2" class="mini-textbox" style="width:100%;"/></td>
 	  			</tr>
 	  		</table>
 	   </div>
 	 </fieldset>
 	 
 	 <!-- ============================== 第三部分 按钮================================================== -->
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	    <div>
	    	<table style="table-layout:fixed;width:100%;" cellpadding="0" cellspacing="10">
	    		 <tr style="width:100%;">
	    		 	 <td style="width:35%;"></td>
		    		 <td style="width:10%;white-space:nowrap;"><a class="mini-button" onclick="" enable="false" style="width:100%;">读身份证</a></td>
				     <td style="width:10%;white-space:nowrap;"><a class="mini-button" onclick="" enable="false" style="width:100%;">信息确认</a></td>
				     <td style="width:5%;white-space:nowrap;"><a class="mini-button" onclick="" enable="false" style="width:100%;">打印</a></td>
				     <td style="width:5%;white-space:nowrap;"><a class="mini-button" onclick="" enable="false" style="width:100%;">放弃</a></td>
				     <td style="width:35%;"></td>
	    		</tr>
	    	</table>
	    </div> 
   </form> 
  </body>
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